Lumboperitoneal shunt in idiopathic normal pressure hydrocephalus: a prospective controlled study.
Massimiliano Todisco, Marta Picascia, Patrizia Pisano, Roberta Zangaglia, Brigida Minafra, Paolo Vitali, Elisa Rognone, Anna Pichiecchio, Roberto Ceravolo, Nicola Vanacore, Alfonso Fasano, Claudio Pacchetti
Author Information
Massimiliano Todisco: Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy. ORCID
Marta Picascia: Alzheimer's Disease Assessment Unit/Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy.
Patrizia Pisano: Neurosurgery Unit, IRCCS San Matteo Foundation, Pavia, Italy.
Roberta Zangaglia: Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
Brigida Minafra: Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
Paolo Vitali: Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
Elisa Rognone: Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
Anna Pichiecchio: Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
Roberto Ceravolo: Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Nicola Vanacore: National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.
Alfonso Fasano: Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Claudio Pacchetti: Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy. claudio.pacchetti@mondino.it.
OBJECTIVE: In this prospective, controlled, monocentric study, we described the clinical and neuroimaging 12-month follow-up of two parallel cohorts of subjects with idiopathic normal pressure hydrocephalus (iNPH), who did or did not undergo lumboperitoneal shunt (LPS). METHODS: We recruited 78 iNPH patients. At baseline, subjects underwent clinical and neuropsychological assessments, 3 T magnetic resonance imaging (MRI), and tap test. After baseline, 44 patients (LPS group) opted for LPS implantation, whereas 34 subjects (control group) declined surgery. Both cohorts were then followed up for 12 months through scheduled clinical and neuropsychological evaluations every 6 months. 3 T MRI was repeated at 12-month follow-up. RESULTS: Gait, balance, and urinary continence improved in the LPS group, without significant influence on cognitive functions. Conversely, gait and urinary continence worsened in the control group. No preoperative MRI parameter was significant outcome predictor after LPS. Of relevance, in responders to LPS, we found postoperative reduction of periventricular white matter (PWM) hyperintensities, which were instead increased in the control group. CONCLUSIONS: LPS is safe and effective in iNPH. An early surgical treatment is desirable to prevent clinical worsening. Post-surgery decrease of PWM hyperintensities may be a useful MRI marker surrogate for clinical effectiveness of LPS.
